We read with great interest the article by Lin and coworkers published recently in Arthritis Care & Research ([1]). In that very well-presented article, the authors aimed to determine the differences in carotid intima-media thickness (CIMT) between patients with psoriatic diseases with and without metabolic syndrome. The authors concluded that psoriatic arthritis patients have an increased prevalence of metabolic syndrome with significantly greater CIMT measurements compared to patients with psoriasis.

Psoriasis as a chronic inflammatory proliferative skin disorder is diagnosed by a variety of immunologic and inflammatory changes and may similarly be a predisposition for those disorders. The role of chronic inflammation causing metabolic and vascular disorders is increasingly being recognized ([2]). Psoriasis is associated with an increased risk of cardiovascular disease. Endothelial dysfunction is the critical early step in the process of atherogenesis, and it is commonly investigated by measuring arterial stiffness. We found that psoriasis patients without known cardiovascular risk factors had higher arterial stiffness when compared with healthy controls in a previous study ([2]). CIMT is now widely used as a surrogate marker for atherosclerotic disease ([3]). We also demonstrated that CIMT measurement was higher in patients with psoriasis compared to the control subjects ([4]). In this context, it may be speculated that increased inflammation of psoriasis contributes to atherogenesis and coronary artery disease.

Psoriasis has a higher prevalence than metabolic syndrome and multiple cardiovascular risk factors are associated with psoriasis ([5]). Metabolic syndrome is a clinical entity comprising risk factors such as hypertension, glucose intolerance, atherogenic lipid profile, abdominal obesity, lack of physical activity, nonalcoholic fatty liver disease, and increased inflammatory state. Some conditions, such as hypertension, diabetes mellitus, coronary artery disease, cerebrovascular disease, peripheral arterial disease, smoking, nonalcoholic fatty liver disease, obstructive sleep apnea, and chronic inflammatory disease, may be associated with psoriasis and can increase CIMT. In this point of view, the authors did not mention some of the affecting factors of CIMT in their study. It would be better if the authors gave information about these factors.

In addition, some medications, such as antihypertensive treatments (including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers), statins, and medications for weight loss, and a medical history of drug addiction may influence CIMT measurements. It would be useful, and the results might be different, if the authors described these factors.

In conclusion, even though psoriatic arthritis patients had an increased prevalence of metabolic syndrome with significantly greater CIMT measurements compared to patients with psoriasis as presented in the study by Lin et al, all of the higher CIMT-related factors should be evaluated in further large-scale prospective randomized clinical trials.

  • 1
    Lin YC, Dalal D, Churton S, Brennan DM, Korman NJ, Kim ES, et al. Relationship between metabolic syndrome and carotid intima-media thickness: cross-sectional comparison between psoriasis and psoriatic arthritis. Arthritis Care Res (Hoboken) 2014;66:97103.
  • 2
    Balta I, Balta S, Demirkol S, Celik T, Ekiz O, Cakar M, et al. Aortic arterial stiffness is a moderate predictor of cardiovascular disease in patients with psoriasis vulgaris. Angiology 2014;65:748.
  • 3
    Demirkol S, Balta S, Celik T, Unlu M, Arslan Z, Cakar M, et al. Carotid intima media thickness and its association with total bilirubin levels in patients with coronary artery ectasia. Angiology 2013. E-pub ahead of print.
  • 4
    Balta I, Balta S, Demirkol S, Mikhailidis DP, Celik T, Akhan M, et al. Elevated serum levels of endocan in patients with psoriasis vulgaris: correlations with cardiovascular risk and activity of disease. Br J Dermatol 2013;169:106670.
  • 5
    Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and metabolic syndrome: a systematic review and meta-analysis of observational studies. J Am Acad Dermatol 2013;68:65462.